Treating someone for a substance abuse problem is a very lengthy and involved process. There are many barriers have that to be broken down, and they have to be broken down with care and insight. That is why before treatment even begins, a doctor or other health care professional needs to know as much about the addict as possible. Not many people know about this step, and it’s important to understand what to expect from the intake and assessment process.
What Happens During the Intake and Assessment Process?
If you’re not sure what “intake and assessment process” refers to, it’s an interview that takes place when an addict checks into a treatment facility. A doctor, or someone else who works at the facility, will ask the addict a number of questions about himself, such as:
- What drugs he is currently taking (and how long he has been taking them, where he got them, etc.)
- If she is on (or supposed to be on) any prescription medication
- Whether he has been diagnosed with mental health conditions
- Whether she has family or other forms of social support
- His family status (whether he is married, if he has any children, etc.)
- What effect her substance abuse has had on her family, social, academic, or professional life
- Family history (in terms of medical history, other cases of substance abuse, or whether there were abuse and neglect within the family)
- Previous treatment history, if applicable
- Criminal history
- What prompted him to take the step of checking into the clinic (an intervention, job loss, ultimatum by a spouse, court order, etc.)
All this data is collected so the clinic can put together an effective and personal treatment plan for the addict. For example, knowing about the presence (or requirement) of prescription medication in the addict’s system will greatly influence the choice of medication that is administered during detoxification. Asking about (and looking out for any symptoms) of mental health conditions will similarly affect the direction of treatment, especially when detox is completed and psychotherapy begins.
The intake interviewer may also ask questions that are more casual and social, such as about the patient’s hobbies and activities. This helps staff get a perception about the patient that is more than a psychological profile. They can understand who the person behind the addiction is, and use that as an anchor to pull the patient through the various changes that he will undergo as a result of treatment.
In addition to questions, the intake can also include other forms of testing, such as a urine analysis, blood test, and breathalyzer. Again, information derived from such tests is used in the creation of a treatment plan for the patient. Clinic staff can also compare the results of these tests with the answers the patient gives to them – for example, to establish how forthcoming the patient will be about her drug or alcohol use when there is physical evidence that may claim otherwise.
Lines of Inquiry
The intake and assessment interview usually takes around an hour and a half. While some of the questions may be quite straightforward (about family status or professional life) or casual (about hobbies and leisure time), others can be difficult for the patient to answer. As shown above, one of the key lines of inquiry in the interview is how the patient’s substance abuse has affected various aspects of his life. A question like this may require care and restraint on the part of the doctor conducting the interview, to extract as much information as possible without inducing feelings of guilt or shame in the patient.
Other difficult questions might be asking the patient to offer a frank and honest opinion of herself. An example of this might take the form of, “How do you feel about yourself?” The question seems innocuous, but such information can shed light on the patient’s state of mind, and whether they have a mental health condition that needs to be taken into consideration when drafting a treatment plan.
A very time-consuming element of the intake and assessment interview is usually when the doctor asks the patient about the nature of the drugs she is taking. It is not enough to simply ask an open-ended question like, “What drugs are you taking?” or “Are you taking other drugs?” since these can be easily dodged by a patient who is reluctant to talk about the extent of their drug use. In fact, a 1999 study published by the Johns Hopkins University School of Hygiene and Public Health, and published in the American Journal of Epidemiology, explained that “underreporting of alcohol intake by individuals is common.”
For that reason, the interviewer will ask about dozens of drugs, one by one – cocaine, heroin, marijuana, alcohol, prescription drugs, methamphetamines, etc. – in an attempt to get as thorough and as complete a picture of the patient’s drug use and history as possible.
Of course, it is possible that the patient may lie in response to each of these questions, but intake staff members are trained to recognize signs of deception (body language, eye contact, etc.). They know that a period of observing the patient, and talking with their friends and family, may reveal information about drug use that the patient did not disclose during the interview.
Another area to cover might be the patient’s cultural background. The American Psychological Association notes the importance of caregivers being aware of ethnic or religious considerations (a female doctor treating a male patient, or dietary restrictions based on religious affiliation, for example) in order to put the patient at ease as much as possible. Questions and details like these should be addressed in the assessment, well before treatment begins.
All the questions, follow-up questions, and time given for the patient to answer as honestly and fully as possible result in the intake interview lasting about 90 minutes.
Between Intake and Treatment
There is usually a small period of time between the conclusion of the intake and assessment process, and the beginning of detoxification. This serves a few purposes. For one, it allows treatment staff to observe the addict to see if more symptoms and evidence of drug use and/or mental health conditions emerge, especially if such drug use and mental health conditions were not disclosed during the intake (because the patient was embarrassed to admit to them, or because the patient simply did not know about them).Another benefit of having a brief break between assessment and detoxification is that it gives time for the clinic staff to devise a treatment plan for the patient. They may use this time to talk with the patient’s family members (if possible), to get more information on the patient’s mental health, behavior and drug history. Detoxification can be a very difficult, stressful, and painful experience for the patient, so the more
information a doctor has before starting treatment, the greater level of care can be administered to make detox as smooth and easy as possible.
One more advantage of the small gap between intake and the start of treatment is that it allows treatment staff to brief and prepare the patient for what is going to come. Checking into a drug clinic can be overwhelming and intimidating for the patient, and rushing into treatment may make them more resistant to the idea. Giving them two or three days to acclimatize to their new surroundings will help put them at ease, and encourage them to be more accepting of the treatment plan that is presented to them. It will also give time for them to learn about the treatment landscape after detox, as well as offer an opportunity to gain reassurance and support from friends and family before treatment begins.
Possession Evaluation (Things the Patient Cannot Bring With Them)
At the intake and assessment stage, staff members will inform the patient what personal belongings they can and cannot bring with them for their stay. Items that may interfere with medication, or trigger cravings will not be allowed. Caffeine, for example, may not be permitted if treatment staff members feel that the patient is vulnerable because of the intensity of the detoxification process. A clinic may take this into account when deciding that a patient is too vulnerable to indulge himself in a potentially addictive and unhealthy food item.
Other items that the patient may not be allowed to have with them during treatment are cigarettes, certain items of jewelry, smartphones/laptops, books or other material that promote drug use, and any beverage with alcoholic content.
To ensure adherence to the rules (and impress the importance of the rules upon patients), clinic staff may conduct random room searches. If contraband is found, penalties may range from warnings and fees to ultimately discharge in the case of repeat or severe offenses.
Payment details are usually settled early in the check-in process, so the patient can focus entirely on treatment without the shadow of impending fees hanging over them. Treatment clinics offer various methods of financing the patient’s stay:
- Credit cards
- Health insurance
- Health care programs (like Medicare, which will cover up to 190 days of inpatient treatment)
- Personal loans
- Home equity loans
Staff members are fully aware that paying for treatment may be the last thing on an addict’s mind, so they will work with the addict and her family to resolve issues of payment as swiftly and transparently as possible.
In some cases, payment information can be settled by phone or email before the actual check-in process; this way, when the patient arrives at the treatment facility, the entire intake and assessment process can be exclusively dedicated to his mental health, and not be distracted by issues of how treatment is going to be afforded.
Treating a drug or alcohol addiction can be expensive, no doubt about it, but as the National Institute of Health puts it, “treatment is less expensive” than leaving a problem untreated, or paying legal fees for wrongdoing committed while under the influence. When health care is factored in, savings can exceed costs by a ratio of 12 to 1.
Similarly, a study done for Health Services Research in 2003 showed that “treatment of substance disorders [appeared to be] cost-effective” when held up against other health measures. Savings from such treatment programs “could be reinvested” for other purposes – for the clinic itself, but also for the patient, who may have to take time off work in order to complete treatment.
Hence, while issues of payment may seem trivial or a diversion away from a bigger issue, taking care of financial issues during the intake process can make a massive difference to the addict’s future.
Learning More About the Intake and Assessment Process
So much emphasis has been put on actual treatment – and understandably so – that many people may be surprised and confused by the thoroughness and meticulousness of the intake process. “Why are there so many questions? Why can’t we just start treatment? Why do you need to know all these things?”